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People older than 65 represent the fastest-growing segment of
the population. More than 20 percent of U.S. residents will be
65 or older in 2030. Of all Americans 65 and older, 14.1 percent
report that they suffer from chronic sinusitis; for those 75
years and older, the rate declines to 13.5 percent. The prevalence
of this condition among the elderly ranks behind arthritis, hypertension,
hearing impairments, heart disease, cataracts, and orthopedic
impairments. However, more Americans report having sinusitis
than diabetes.
- constant need to clear the throat
- a sense of nasal obstruction
- nasal crusting
- vague facial pressure
- decreased sense of smell and taste
For the most part, sinusitis symptoms, diagnosis, and treatment
are the same for the elderly as other adult age groups. However,
there are special considerations in older Americans:
With aging, the physiology and function
of the nose changes. The nose lengthens, and the nasal tip begins
to droop due to weakening of the supporting cartilage. This in
turn causes a restriction of nasal airflow, particularly at the
nasal valve region (where the upper and lower lateral cartilages
meet). Narrowing in this area results in the complaint of nasal
obstruction, often referred to as geriatric rhinitis.
Patients with geriatric rhinitis typically complain of constant "sinus
drainage," a chronic need to clear the throat or "hawk" mucus,
and a sense of nasal obstruction, most often when they lie down.
Other features include nasal crusting especially in the winter
and in patients taking diuretics, vague facial pressure (attributed
to "sinus trouble"), and a decreased sense of smell
and taste.
However, it is a mistake to blame all upper respiratory problems
on the aging process. Elderly patients with symptoms such as
repeated sneezing, and watery eyes, nasal obstruction with clear
profuse watery runny nose, and soft, pale turbinates (top-shaped
bones in the nose) may have allergic rhinitis. Patients with
this diagnosis will benefit from consultation with an otolaryngic
allergist.
Patients with chronic sinusitis will have a long history of
thick drainage that is often foul smelling and tasting and is
associated with nasal obstruction, headaches, and facial pressure.
These patients usually have pus drainage and nasal redness. In
contrast, the geriatric rhinitis patient usually has a dry, irritated
nose. The diagnosis of chronic sinusitis can be confirmed with
a screening coronal CT of the sinuses.
Recent studies by otolaryngologist-head and neck surgeons have
sought to better define the association between rhinitis and
sinusitis. They have concluded that sinusitis is often preceded
by rhinitis and rarely occurs without concurrent rhinitis. The
symptoms, nasal obstruction/discharge and loss of smell occur
in both disorders. Most importantly, computed tomography (CT
scan) findings have established that the mucosal linings of the
nose and sinuses are simultaneously involved in the common cold
(previously, thought to affect only the nasal passages). Otolaryngologists,
acknowledging the inter-relationship between the nasal and sinus
passages, now refer to sinusitis as rhinosinusitis.
The fluids within these cavities are dynamic and are related
to dynamic pathologic changes in the bone and soft tissues of
the nasal cavity and paranasal sinuses. Symptoms associated with
rhinosinusitis include nasal obstruction, nasal congestion, nasal
discharge, nasal purulence, postnasal drip, facial pressure and
pain, alteration in the sense of smell, cough, fever, halitosis,
fatigue, dental pain, pharyngitis, otologic symptoms (e.g., ear
fullness and clicking), and headache.
Osteoporosis is a significant health problem in
the United States affecting approximately 24 million Americans,
15 to 20 million of whom are women over 45 years of age. Because
of the concerns regarding prolonged estrogen use in postmenopausal
women, a nasal calcitonin spray is often prescribed to prevent
bone loss in perimenopausal women who cannot tolerate estrogen.
The most common side effect reported with nasal calcitonin spray
is a runny nose. Other symptoms that may occur include nasal
crust, dryness, redness, irritation, sinusitis, nose bleeds,
and headache. Sinusitis sufferers using a nasal calcitonin spray
should advise their physicians.
Treatment for this age group needs to be more individualized
to meet the patient's slower metabolism and the increasing potential
for side effects. The majority (80 to 85 percent) of the nation's
elderly have chronic diseases and take multiple drugs including
over-the-counter medications, and risk drug interactions more
often than other patients.
Nasal and sinus surgery is occasionally advised for
older patients. Patients with structural abnormalities, such
as a deviated septum or nasal valve collapse causing severe nasal
problems, should be referred to an otolaryngologist for evaluation
and possible surgical management. Patients with documented chronic
sinusitis unresponsive to medications also should be referred
to an otolaryngologist.
Administration on Aging (AoA), U.S. Department of Health
and Human Services; Geriatrics.
© 2004 AAO-HNS/AAO-HNSF
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